Dual Microcatheter Retrograde Transvenous Obliteration of Gastric Varices: Coil Embolization as a Substitute for Balloon Occlusion

Dual microcatheter retrograde transvenous obliteration (DMRTO) of gastric varices enables dual microcatheters to be advanced to the gastric varices themselves or to a site adjacent to the varices. The sclerosing agent is infused through the first microcatheter following coil embolization of the outflow vessels through the second microcatheter, which is placed several centimeters back from the varices. We present two cases of gastric varices in whom balloon-occluded retrograde transvenous obliteration failed, because of angulated gastrosubphrenic shunt in case 1 and a tortuous and elongated gastrorenal shunt in case 2. DMRTO successfully achieved eradication of the gastric varices in both cases

The association of ectopic craniopharyngioma in the fourth ventricle with familial adenomatous polyposis: illustrative case

[BACKGROUND] Craniopharyngioma (CP) often arises in the sellar and suprasellar areas; ectopic CP in the posterior fossa is rare. Familial adenomatous polyposis (FAP) is a genetic disorder involving the formation of numerous adenomatous polyps in the gastrointestinal tract, and it is associated with other extraintestinal manifestations. [OBSERVATIONS] The authors reported the case of a 63-year-old woman with FAP who presented with headache and harbored a growing mass in the fourth ventricle. Magnetic resonance imaging (MRI) findings revealed a well-circumscribed mass with high intensity on T1-weighted images and low intensity on T2-weighted images and exhibited no contrast enhancement. Gross total resection was performed and histopathology revealed an adamantinomatous CP (aCP). The authors also reviewed the previous reports of ectopic CP in the posterior fossa and found a high percentage of FAP cases among the ectopic CP group, thus suggesting a possible association between the two diseases. [LESSONS] An ectopic CP may be reasonably included in the differential diagnosis in patients with FAP who present with well-circumscribed tumors in the posterior fossa

Usefulness of Microcatheters Inserted Overnight for Additional Injection of Sclerosant after Initial Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

In patients with large gastric varices, dose limitation of the sclerosant can cause difficulties in achieving complete thrombosis of varices during a single balloon-occluded retrograde transvenous obliteration (BRTO) procedure. For patients with incomplete variceal thrombosis after the first BRTO, additional sclerosant must be injected in a second BRTO. We report a successful case of BRTO for large gastric varices in whom additional sclerosant was injected through a microcatheter that remained inserted overnight. To achieve complete variceal thrombosis in a patient with incomplete thrombosis of large gastric varices after a first BRTO, a retained microcatheter can be used to inject additional sclerosant in a second BRTO the next day

Computed Tomography Fluoroscopy-guided Biopsy of Lung Nodules: Comparison of the Step-wise and Realtime Techniques

The present study aimed to compare the step-wise and real-time techniques for computed tomography (CT) fluoroscopy-guided biopsy of lung nodules. It included 72 consecutive patients (50 men, 22 women; mean age: 71.8 years; range: 45–89 years) with lung nodules. Between March 2017 and April 2019, 72 CT fluoroscopy-guided biopsy procedures were performed using either the step-wise (n = 34) or real-time technique (n = 38). The diagnostic accuracy was 97.1% for biopsies performed using the step-wise technique and 94.7% for those performed using the real-time technique (p = 0.39). The mean CT dose index was 48.8 ± 16.9 mGy/s for the step-wise method and 59.9 ± 25.6 mGy/s for the real-time method; the dose length product was 1956 ± 729 mGy and 2613 ± 1300 mGy for the two techniques, respectively (p < 0.05). There was a significant difference in mean exposure time (81 ± 43 s for the step-wise technique and 162 ± 120 s for the real-time technique; p < 0.05). The mean lung nodule size was also significantly different (29.9 ± 17.6 mm for the step-wise method and 17.8 ± 12.2 mm for the real-time method; p < 0.01). Of the 34 step-wise procedures, 11 (32.4%) resulted in pneumothorax, as did 24 of 38 (63.2%) real-time procedures (p < 0.01). The real-time technique is particularly useful in patients with small nodules. The CT dose, exposure time, and incidence of pneumothorax were significantly lower when the step-wise technique was applied to CT fluoroscopy-guided biopsy of lung nodules

Aortic ostia of the bronchial arteries and tracheal bifurcation: MDCT analysis

AIM: To explore the anatomical relationships between bronchial artery and tracheal bifurcation using computed tomography angiography (CTA)

Permissive untreated pseudoaneurysm concept in damage control interventional radiology for traumatic pancreaticoduodenal artery injury

Background Angioembolization for traumatic pancreaticoduodenal artery injury with unstable circulation, which characteristically requires a prolonged procedure time, does not yet have a standardized strategy for damage control interventional radiology. Case Presentation We encountered two cases of rare traumatic pancreaticoduodenal artery injury wherein the patients were saved by a multidisciplinary team with a shared goal of clinical success, rather than the procedural success of angioembolization. Both patients treated with angioembolization had residual pseudoaneurysm or faint extravasation in the pancreaticoduodenal artery arcade. We prioritized critical care with preemptive plasma transfusion and aggressive blood pressure control, and planned repeat angiography. The patients showed no clinical signs of rebleeding or pseudoaneurysm based on computed tomography during follow‐up. Conclusion Our findings suggest that the permissive untreated pseudoaneurysm concept can be useful in developing damage control interventional radiology strategies for trauma cases with challenging time limitations, such as traumatic pancreaticoduodenal artery injury with circulatory collapse

Balloon-occluded retrograde transvenous obliteration for gastric varices via the intercostal vein

Gastric varices are usually associated with a gastro-renal (G-R) shunt. However, the gastric varices described in this case report were not associated with a G-R shunt. The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein. First, percutaneous transhepatic obliteration of the posterior gastric vein was performed, but the gastric varices remained patent. Then, micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein, pericardial vein and cardio-phrenic vein, however, micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment. Thereafter, as a gastro-subphrenic-intercostal vein shunt developed, a micro-balloon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration (BRTO) was performed resulting in the eradication of gastric varices. BRTO for gastric varices via the intercostal vein has not previously been documented